Medscape: Post-Exertional Malaise in Fatiguing Diseases: What to Know to Avoid Harmful Exercise - by Miriam Tucker

Quote:

Identifying the phenomenon of post-exertional malaise (PEM) in patients with fatiguing conditions is critical because it necessitates a far more cautious approach to exercise, experts said.

PEM is a defining feature of the condition myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and it is present in many people with long COVID. It is characterized by a worsening of fatigue and of other symptoms after previously tolerated physical or mental exertion, typically emerging 24-72 hours after the exertion and lasting days or weeks thereafter. The experience is often called a “crash.”

In a study presented at American College of Rheumatology (ACR) 2024 Annual Meeting, PEM was also identified in people with various rheumatologic conditions, ranging from 4% in those with osteoarthritis to 20% in those with fibromyalgia. The presence of PEM was also associated with worse pain, sleep, cognition, and other symptoms that are also characteristic of ME/CFS and many cases of long COVID.


https://www.medscape.com/viewarticl...tiguing-diseases-what-know-avoid-2024a1000ot1

 

If true, that would be interesting, possibly showing that PEM was due to immune system activation.

 

The study referred to is "Prevalence of Post-exertional Malaise (PEM) in Adults with Rheumatic Diseases and Relationship with COVID19 Infection" (Arthritis Rheumatol. 2024; 76 suppl 9) and used the PEM sub-scale questions from the DSQ:

https://acrabstracts.org/abstract/p...ases-and-relationship-with-covid19-infection/

 

I almost feel we need to distinguish between two bits of PEM.

PESE which is the worsening or triggering of symptoms, I wouldn’t be surprised if this also happens in various other diseases.

PEBD? (post exertional baseline deterioration)? which is that “crash” where you have limited capacity do things you could outside of a crash, importantly the amount of exertion that induces more PEM is lowered. So basically induced functional disability from exertion. This is where that spiral of continuing to overexert while you are in a crash can lead to sort of “recursive” crashes which seem to be a common experience of how someone with the illness significantly deteriorates in severity. I doubt this is present in any other illnesses.

 

Putting aside the issues with DSQ for a moment, another explanation could be that those people who indicate PEM might actually have ME/CFS, whether through a mis-diagnosis or as a comorbidity.

 

Indeed. 'Osteoarthritis' is pretty much a joke diagnosis anyway. Everyone over 60 qualifies for it. Fibromyalgia is understood to have major overlap with ME/CFS. RA includes a post-exertional symptom exacerbation that bears no relation to that in ME/CFS. And so on.

 

Changed
Mon, 12/23/2024 - 11:07

https://medauth2.mdedge.com/content...ing-diseases-what-know-avoid-harmful-exercise

 

What is the post-exertional symptom exacerbation that is included in RA that is not like ME?

 

If you do a lot on day one then you are likely to wake up very stiff in the used joints on day two. It is a specific problem of rebound joint lining oedema as an exacerbation of chronic inflammatory infiltration. It takes about 12 hours, and a periodic of inactivity, to become manifest.

What I think that demonstrates is that simplistic descriptions of things like PEM or PESE are nothing like adequate to pick out symptom patterns that need to be recognised to make sensible medical decisions. Everything has to be seen in a huge context of related factors.

Lists of symptoms and questionnaires are never going to pick out diagnoses.

 

Ahh thank you. Yeah.

 

@Jonathan Edwards - could you expand on this comment? In what way is the post-exertional symptom exacerbation in RA different from that in ME/CFS? I'm trying to understand how doctors might differentiate the two